Journal Article

Microneedling-assisted delivery of metformin versus tranexamic acid in treating melasma: a randomized controlled study

Kadah, Ahmed S., Elsaie, Mohamed L., Mahran, Mohamed A., Al Mohammady, Abdelshakour

2025

Overview

Background Melasma is a common, relapsing hyperpigmentation disorder with limited long-term treatment success. Recent advances suggest that microneedling may enhance the transdermal delivery and efficacy of topical agents. This study compares the clinical outcomes of microneedling-assisted delivery of topical metformin and tranexamic acid (TXA) in the treatment of facial melasma, with modified Kligman’s formula as a control. Objectives To evaluate and compare the efficacy, safety, and patient satisfaction of microneedling with topical metformin versus TXA in melasma patients. Methods: Forty-five female patients with facial melasma were randomized into three equal groups. Group A received microneedling with topical metformin; Group B received microneedling with topical TXA; Group C applied modified Kligman’s formula nightly. Treatments were conducted over 8 weeks. Outcomes included changes in modified Melasma Area and Severity Index (mMASI), patient satisfaction scores, pain levels, and adverse events. Results: All groups showed significant mMASI reductions. Group B achieved the greatest reduction (mean 45.3%) followed by Group C (38.2%) and Group A (22.1%) ( p  < 0.001). Satisfaction scores were highest in Group B, with 33.3% reporting marked improvement. Minimal adverse events were reported across all groups, with no serious side effects. Pain scores were comparable between microneedling groups. Conclusion Microneedling with topical TXA demonstrated superior efficacy and patient satisfaction compared to metformin and Kligman’s formula. While topical metformin showed some potential, its formulation and clinical utility require further study. Microneedling offers a promising approach to improve treatment outcomes in melisma. Graphical Abstract

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acids / Administration, Cutaneous / Adult / Biomedicine / Care and treatment / Diabetes therapy / Disease / Family medical history / Female / Humans / Infectious Diseases / Internal Medicine / Kinases / Medicine / Medicine & Public Health / Melanosis / Melanosis - drug therapy / Melasma / Metformin / Metformin - administration & dosage / Microneedling / Middle Aged / Needles / Oncology / Patient Satisfaction / Percutaneous Collagen Induction / Polyethylene glycol / Surgery / Tranexamic acid / Tranexamic Acid - administration & dosage / Transdermal medication / Treatment Outcome